Wal-Mart Stores East LP
Organization Active NPI Community/Retail Pharmacy · Cleveland, OH
NPI 1811914005 · NPPES record last updated Jun 5, 2025
Key facts
- NPI
- 1811914005
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- License
- 020766950 (OH)
- Legal business name
- WAL-MART STORES EAST LP
- Practice address
- 10000 Brookpark Rd
Cleveland, OH 44130-1102 - Phone
- (216) 741-7386
- NPI assigned
- Jul 16, 2006
- Organization subpart
- No
Authorized official
- Name
- Kimberly Canonic
- Title
- Senior Director, Enrollment
- Phone
- (480) 277-6348
Corporate family (same tax ID) 24
Member of 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in OH
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100930087306 | OH | DME Supplier - Pharmacy |
6204749997 | Practice locations: Cleveland, OH |
| O20131203001976 | OH | Part B Supplier - Mass Immunization (Roster Biller Only) | 6204749997 | This NPI is an additional NPI on the enrollment |
National Provider Directory
- Tax ID family
- Ability Network
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | |||
| Pharmacy | 333600000X | |||
| Community/Retail Pharmacy | 3336C0003X | 020766950 | OH | Yes |
Addresses
Primary practice location
10000 Brookpark Rd
Cleveland, OH 44130-1102
Mailing address
702 SW 8TH St
Bentonville, AR 72716-0445
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 956998 | Medicaid | OH | |
| 2073292 | Other | PK | |
| 0956998 | Medicaid | OH |
Other names
- WAL-MART PHARMACY 10-2073
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service | Other | Ability Network |
Other providers in Cleveland, OH
- Brett Wakefield
- Teresa Lafaye Wakefield
- Andrew Wakeling
- Jamile Wakim-Fleming
- Ryan T Wakley
- Wal-Mart Stores East LP
- Wal-Mart Stores East, LP
- Robert Walchack
- Jamie Alice Walcheski
- David N Wald
All providers in Cleveland, OH · Community/Retail Pharmacy in Ohio
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 5, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.